HomeMy WebLinkAbout02-18-14 (2) t �
� 1505610105
REV-1500 EX(oz-11)(FI)��-
PA Department of Revenue pennsylvania oFFICIAL USE ONLY
Bureau of Individual Taxes �""pT�`"T�`"`�`"�` County Code Year File Number
PO BOX 28o6oi
INHERITANCE TAX RETURN � j�
Harrisburg,PA i'7128-o6oi RESIDENT DECEDENT �� � ,
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
__ __ __ __ _ _
! 03/25/2012 ' 08/02/1939
DecedenYs Last Name Suffix DecedenYs First Name MI
Eagles ', ', Ella ' ,1 ',
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
_ REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Return p 2.Supplemental Return O 3. Remainder Return(Date of Death
Priorto 12-13-82)
O 4.Limited Estate p 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust � 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
_ _ __ _
Law Office of John C Oszu��p�y�i��L (717)243-7437 .
_._ _ _ __ _ _ _ ___ _ __
REGISTER�WILLS USE aNLY
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_ _,..� ....�
First Line of Address '� r � ' ' -,
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__ _ _t., ,_ , , .
104 S Hanover St "'"" � `,-'�
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Second Line of Address ��
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TE�FILED � - '���
City or Post Office . . State . ZIP Code . -_ -��
Carlisle PA 17013 ` �
_ _ ,
Correspondent's e-mail address:
Under penalties of peryury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNfyT�.l�2,E`/`O,F P ON RESPONSIBLE FOR FILING RETURN ZI I b� I�
��
ADDRESS
127 W Louther St., Carlisle, PA 17013
SIGNAT F P RER OTHER THAN REPRESENTATIVE DATE
Z 1
ADDR S
104 Hanover St., Carlisle, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610105 1505610105 J
hu�
ti �
J 15�5610205
REV-1500 EX(FI)
DecedenYs Social Security Number
DecedenYs Name: ! '
RECAPITULATION
_ _ _
1. Real Estate(Schedule A). ......................................... ... L I '
2. Stocks and Bonds(Schedule B) ....................................... 2. I
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. '
4. Mortgages and Notes Receivable(Schedule D). ... ............. .......... 4. '
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 8,427.70 ;
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. '
7. Inter-�vos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7. ', 323,589.50 ''
8. Total Gross Assets(total Lines 1 through 7).................... ......... 8. ' 332,017.20 '
9. Funeral Expenses and Administrative Costs(Schedule H)................ ... 9. ' 19,276.27 !
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I).. ............. 10. , 74,499.11 '
11. Total Deductions(total Lines 9 and 10)................................. 1L '; 93,775.38 '
12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. ; 238,241.82 '
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which �" � � �� � W ^�
an eiection to tax has not been made(Schedule J) .......... .............. 13. ' '
14. Net Value Subject to Tax(Line 12 minus Line 13) .. ............. ... ... ... 14. ' 238,241.82 '
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 __ __ _ _
�a)�1.2)X.0- ' ' 15. '.
_. �__ - . ..,..... . . ..... . �_ _....� .... H____. „ .
16. Amount of Line 14 taxable '
at lineal rate X.0_ ', 16. '
.....
17. Amount of Line 14 taxable ' °
at sibling rate X.12 ' 17. j
_a_ _.... � _ .. .. _ .__. :
18. Amount of Line 14 taxable 238,241.82
at collateral rate X.15 ' �g. ', 35,736.27 ',
19. TAX DUE ....................................... .................. 19.', 35,7$6.27 '
_ _
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Side 2
� 1505610205 1505610205 J
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Ella J Eagles
STREETADDRESS
4905 E.Trindle Road
CITY STATE ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 35,736.27
2. CreditslPayments
A.Prior Payments
B.Discount
Total Credits(A+B) (2)
3. Interest
(3) 1,251.76
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 36,988.03
Make check payable to: REGISTER OF WILLS,AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred.......................................................................................... ❑ �
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ �
c. retain a reversionary interest.............................................................................................................................. ❑ �
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ �
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ �
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ �
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? ........................................................................................................................ � ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
; ,. _
� � �: ,.
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For dates of death on or after July 1,1994,and before Jan. 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
. The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decetlenYs lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)].
. The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-15o8 EX+(o8-i2)
� pennsylvania SCNEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Ella J Eagles 21-13-0093
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule P.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PSECU Checking Account 452644727 6,623.72 '
2 `PSECU Savings Account 213.78
3 Prudential Life Insurance Policy Contract#D10830627 1,590.20
TOTAL(Also enter on Line 5, Recapitulation) $ 8,427.70 ,
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(08-09}
��� SCHEDULE G
y � �� pennsylvania
�- DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND
� INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY �
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ella J Eagles 21-13-0093
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEAEE,iHEl0.0.ELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD�S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSfER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1• 39 Shares Fulton Financial common stock @$10.50 409.50 100 409.50
2 10 Cumberland County PA Mun Bond @$99.937 9,993.70 100 9,993.70
3' 2271.922 sh Fidelity Advisor Mutual Fund @$9.86 22,401.15 100 22,401.15 '
4 7551.525 sh Franklin Income Mutual Fund @$2.20 16,613.35 ' 100 16,613.35
5 9659.211 sh Oppenheimer Funds Mutual Fund @$7.18 69,353.13 100 69,353.13
6 8275.723 sh Pioneer Global Mutual Fund @$9.97 82,508.95 100, 82,508.95
� John Hancock Annuity Contract#2066329 60,971.20 100 60,971.20
8 Pacific Life Annuity Contract#VT00021361 5,417.92' ' 100 5,417.92
9 'MetLife Investors Annuity Contract#1100933821 19,907.90 100 19,907.90
�� MetLife Investors Annuiry Contract#1100933839 13,951.77 100 13,951.77
11 MetLife Investors Annuity Contract#99240552 22,060.93 100 22,060.93
See Exhibit"A" for transfer information
TOTAL(Also enter on Line 7, Recapitulation) $ 323,589.50
If more space is needed,use additional sheets of paper of the same size.
REV-I511 EX+ (08-13)
� pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ella J Eagles 21-13-0093
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Neill Funeral Home-Harrisburg, PA 7,520.18
Food for Memorial Service 347.39
B, ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name{s)of Personal Representative(s)
Street Address
City _ State ZIP
Year(s)Commission Paid:
2• Attorney Fees:
10,975.00 '`
3. Family Exemption: (If decedenYs address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 188.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
�• Legal Advertising-Cumberland County Law Journal 75.00
s Legal Advertising-The Sentinel 115.20
s VitalChek-additional death certificates 55.00
TOTAL(Also enter on Line 9, Recapitulation) � 19,276.27
If more space is needed,use additional sheets of paper of the same size.
REV-1577 EX+ �12-12)
� pennsylvania SCHEDULE I
DEPARTMENTOFREVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RERJRN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ella J Eagles 21-13-0093
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1• DCM Services-pharmacy bill 797.25'
2 US Treasury- 2012 Income tax due 459.00'`
3 'PA Dept of Revenue-2012 Income tax due 321.00
4 'Diamond Pharmacy-pharmacy bill 537.13
5 David Zug-Trust administration fee 200.00
6 In Your Home Care-nursing services 105.00
7 West Shore EMS 206J5
8 Country Meadows-Nursing home care Feb&Mar 2012 10,934.00
9 Margin Balance on Wells Fargo Trust Account 60,938.98
TOTAL(Also enter on Line 10, Recapitulation) ; 74,499.11 '
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
,.
��3.: pennsylvania SCHEDULE �
DEPARTMENT OF REVENUE
� � � INHERITANCETAXRETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Ella J Eagles 2013-00093
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
i. David R.Zug 127 W.Louther St.,Carlisle,PA 17013 Cousin 62399.29
2 Michael Zug 570 Rosewood Lane,Harrisburg,PA 17111 Cousin 62399.27
3 Stephen Zug 107 S.Arlington Ave.,Harrisburg,PA 17109 Cousin 84460.22
4 'Amanda Fritz 127 W Louther St.,Carlisle,PA 17013 Aunt 28983.03
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
L
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
. -�----� �i�a J Ea9��s Zi - � 3 - oa� 3 ��,� �i ZS
_1 P.O. eox 67013 (111) 234•848�arrisburg)
S�eC�'�11��e � Harrisburg,PA U106•7013 (800) 231•1328(Nationwide)
website - http://www.psecu.com 1
JOINT OWNER
ELLA J EAGLES
127 W LOUTHER ST .
CARLISLE PA 17013-2936
MEMBER NUMBER STATEMENT DATE
0206XXXXXX i 04/30/12
Post Eff Description Amount Balance
04/O1 ID O1 REGULAR SHARE Beginning Balance 213.74
09/30 Payment: Dividend 0.250� 0.04 213.78
Annual Percentage Yield Earned 0.230� from 09/O1/12 through 09/30/12
Based on Average Daily Balance of 213.79
04/30 Ending Balance 213.78
Dividend YTD: Year to Date 0. 18
--- ---- -------
Post Eff Description Amount Balance
09/O1 ID 09 CHECKING Beginning Balance 6623.72
04/02 Withdrawal Direct Deposit CAPITALBLUECROSS 208.69- 6915.03
TYPE: INS. PREM ID: 1230955159
C0: CAPITALBLUECROSS
09/02 Payment: By Check 3000.00 9915.03
04/04 Check 000553 200.00- 9215.03
04/09 Check 000559 347.39- 8867.69
04/20 Withdrawal Check Card 26.29- 8939.90
04/19 2469216FYOOADTZAO 4899 VERIZON*RECURRINGPAY 800-VERIZON PA
09/30 Payment: Dividend 0. 100� 0.72 8890.12
Annual Percentage Yield Earned 0. 100$ from 09/O1/12 through 09/30/12
Based on Average Daily Balance of 8818. 98
09/30 Ending Balance 8840.12
Dividend YTD: Year to Date 2.52
Number Amount Number Amount Number Amount Number Amount
000553 200.00 000559 347.39
--------- --------------------
Post Eff Description Amount Balance
04/O1 ID DD DIVIDEND DISBURSEMENT Beginning Balance 0.00
04/30 Ending Balance 0.00
Dividend YTD: Year to Date 0.00
Total Dividend YTD: Year to Date 2.70
Total Dividend YTD: Year to Date 2.70
Exhibit A
SCHEDULE G
Transferee information
Estate of Ella J Eagles File #21-13-0093
Items 1-6 are being held in trust at Wells Fargo. The will be distributed upon the State of PA's
approval of the Inheritance Tax Return. These items will be divided evenly and distributed to the
following transferees:
1. David Zug - COUSIN
127 W Louther St.
Carlisle, PA 17013
2. Michael Zug - COUSIN
570 Rosewood Lane
Harrisburg, PA 17111
3. Stephen B. Zug, Sr. - COUSIN
107 S. Arlington Ave.
Harrisburg, PA 17109
4• Amanda Fritz - ALJNT
127 W Louther St.
Carlisle, PA 17013
Item 7: Distributed 6/29/12 to transferee# 1, 2, 3
Item 8: Distributed 6/19/2012 to transferee #1, 2, 3
Item 9: Distributed 10/19/2012 to transferee#1, 2, 3
Item 10: Distributed 10/18/2013 to transferee# 1, 2, 3
Item 11: Distributed 2/7/13 to transferee#3
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